This is the presentation by Dr. Hung-Bin Tsai to introduce the hospitalist program in National Taiwan University Hospital at International Hospital Medicine Forum of Hospital Medicine 2014.
College Call Girls Hyderabad Sakshi 9907093804 Independent Escort Service Hyd...
Hospital Medicine around the World- Taiwan Experience
1. 1
Dr. Hung-Bin Tsai
Division of Hospital Medicine, Department of
Traumatology, National Taiwan University Hospital
March 25, 2014
Hospital Medicine Around the World
- Taiwan Experience
Special Interest Forum 2014
2. National Health Insurance in Taiwan (TNHI)
Started on March 1, 1995
Spend 6.6% GDP for health in 2011.
Compulsory social health insurance program for all
citizens from birth
Health Insurance IC Card
Second Generation National Health Insurance System2
3. Payment System of TNHI
Healthcare institutions signed contracts with the BNHI:
92.47%
Early years : “fee-for-service”
→ spiraling growth of medical cost
Pay-for-performance system (first introduced in 2001)
breast cancer therapy, diabetes, asthma and hypertension treatment
Global Budget Payment System
Taiwanese version of the Diagnosis Related Groups
(Tw-DRGs)
adopted 111 DRGs into practice for the first year (2010) and would take 5
years to phase in the complete system (more than 500)
4. The Hospitalist Program in National
Taiwan University Hospital (NTUH)
Founded in Oct. 2009 Current 8 Hospitalists
Teaching: yes
Services offered:
Medical management of multimorbid patients
Consultative services
Co-management of surgical patients
Palliative care
Medical education to nurse practitioners & nurses
Quality improvement
Information technology
Integrated post-discharge transitional care (PDTC) 4
5. Current situation of Hospital Medicine
in Taiwan
Leading hospitalist program in Taiwan:
NTUH, since Oct 2009.
Hospitalist program for 2-year young VS
obligation for primary care: Chang-Gang
Medical Center, since 2006
ED observation units model:
Chi Mei Medical Center in Southern Taiwan,
since Aug 2012.
5
6. Potential implications of Hospital Medicine in the
development of best practice models in Taiwan.
Co-management for surgical patients
Reduce weekend effect of adverse outcome for
weekend admission patients
Post-discharge transitional care
Palliative care for multimorbid aged patients
6
7. J Hosp Med 2011;378-382
Higher clinical severities of
patients in hospitalist-run
vs. Internalist-run ward
Hospitalist-run vs. Internalist-run Ward:
[After Propensity score matching]
Less LOS for 6 days
Less admission cost per patient: 3,590
USD
Less paid by NHI per patient:
3,202 USD
9. NTUH Hospitalist program reduce weekend
effect of adverse outcome
(Propensity score matching)
Weekday
admission
(n =496)
Weekend
admission
(n=496)
P value
Age (yr) 70.1 ± 15.6 70.0 ± 15.8 0.930 a
Male gender 249 (50.2) 251 (50.6) 0.899 b
Chronic disease
CCI, unadjusted 2.6 ± 2.5 2.5 ± 2.4 0.432 a
ED triage level 0.703 b
1-2 256 (51.6) 262 (52.8)
3-5 240 (48.4) 234 (47.2)
BI at admssion 53.9 ± 36.9 51.3 ± 36.5 0.276 a
Malignancy 103 (20.8) 109 (22.0) 0.699 b
Outcomes
ICU admission 9 (1.8) 5 (1.0) 0.299 b
CPR event 1 (0.2) 3 (0.3) 0.374 b
DNR consent 97 (19.6) 94 (19.0) 0.872b
Hospital mortality 42 (8.5) 40 (8.1) 0.818b
10. BMC Med. 2011 Aug 17;9:96.
PLoS One 2013
Post-discharge Transitional Care (PDTC)
Can Reduce Readmission Rate and Mortality
10
Pearls of PDTC:
8AM-8PM Call Center + Follow-up
clinic in hospitalist-run ward
2 case managers to make phone calls
Followed on post-discharge
1,7,14,30 days
11. Our Challenges
What are the needs to run local programs and chapters
of Hospital Medicine?
To redesign clinical schedule (need time for academic
work)
- Pair hospitalists, 2 wards by 4 teams
8a-6p for 7 or 14 days
- Each team care 18 patients by 1 doc & 2 NPs
To relieve night shift burden
- on duty 6 nights per month
- we need moonlighters/nocturist!
11
12. Our Challenges
What is the potential role of SHM in terms of
teaching, research and networking?
1.One of the successful hospitalist programs in North-
East Asia.
2.We wound design more detailed post-discharge
transitional care model to link intermediate care
(post-acute care)
3.To compare different interprofessional coordinated
care models in USA, EU, Asia.
12
13. Suggestions to improve the international
section and the HMX community
Regional annual experts meeting for consensus of
best practice model in hospital medicine.
Encourage short-term (6 month to 1 year)
exchange program for fellows to learn different
models in healthcare system (such as palliative
care).
To compare the burn-out index of hospitalists in
different healthcare systems. 13
15. Thanks for your attention!
My Official E-mail: hbtsai@ntuh.gov.tw
If you talk to a man in a language he
understands, that goes to his head.
If you talk to him in his language, that
goes to his heart.
~Nelson Rolihlahla Mandela
Editor's Notes
It uses private-sector providers, but payment comes from a government-run insurance program that every citizen pays into. Since there's no need for marketing, no financial motive to deny claims and no profit, these universal insurance programs tend to be cheaper and much simpler administratively than American-style for-profit insurance.
The classic NHI system is found in Canada, but some newly industrialized countries -- Taiwan and South Korea, for example -- have also adopted the NHI model
1.Demand for PDMC may be as high as 29% in home care patients within 30 days after discharge.
PDMC is needed more by patients with malignancy and lower BI.
2.More focus should also be given to those with lower BI, higher CCI, and longer length of hospital stay, as they more frequently have red flag signs.
樹金忠文章: PLoS One 2013